Skip to main content

Blood Bank

Prevention of Infection

The safety of laboratory personnel is paramount in Blood Bank, a department where the handling of human blood is constant and high-volume. The primary regulatory framework governing safety practices is the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard (29 CFR 1910.1030). This federal regulation mandates specific practices to protect workers from exposure to human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and other potential pathogens. The overarching philosophy used to implement this standard is the concept of Standard Precautions

Standard Precautions

Standard Precautions (formerly Universal Precautions) is an approach to infection control which treats all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV, and other bloodborne pathogens. There is no distinction made between a “high-risk” sample and a “routine” sample; every tube, bag, and segment is handled with the same high level of caution

  • Scope: Applies to blood, all body fluids, secretions, and excretions (except sweat), regardless of whether they contain visible blood
  • Application: Standard Precautions are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered

Hierarchy of Controls

To prevent infection, laboratories must implement a hierarchy of controls. The most effective controls remove the hazard or isolate the worker from the hazard, while the least effective rely on worker behavior

Engineering Controls

Engineering controls are physical devices or equipment that isolate or remove the bloodborne pathogen hazard from the workplace. These are the first line of defense because they function independently of the worker’s behavior

  • Segment Sampling Devices: In Blood Bank, removing blood from donor tubing segments is a high-risk activity due to the pressure buildup within the segment. Engineering controls include mechanical segment piercing devices (e.g., automated segment samplers) that keep the blood contained within a test tube, eliminating the spray hazard
  • Safety Needles and Sharps: Usage of self-sheathing needles or needleless transfer systems for blood culture or tube transfers
  • Sharps Disposal Containers: Puncture-resistant, leak-proof, color-coded (red) or labeled containers located at the immediate point of use for the disposal of needles, lancets, and broken glass
  • Plasticware: Replacing glass capillary tubes and serological tubes with plastic alternatives to reduce the risk of cuts and subsequent pathogen entry
  • Splash Shields: Acrylic barriers placed on the benchtop to protect the laboratory scientist’s face during stopper removal or segment cutting

Work Practice Controls

Work practice controls reduce the likelihood of exposure by altering the manner in which a task is performed. These rely on the laboratory scientist’s discipline and adherence to policy

  • Hand Hygiene: Hands must be washed with soap and water immediately after removing gloves and after any contact with blood or potentially infectious materials
  • Prohibited Actions: Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are strictly prohibited in work areas where there is a reasonable likelihood of occupational exposure
  • Minimizing Aerosols: Centrifuges must be covered or have sealed buckets. If a tube breaks during centrifugation, the centrifuge must be allowed to stop and settle (usually 30 minutes) before opening to allow aerosols to disperse
  • Segment Opening Technique: If a mechanical device is not available, segments should be cut with scissors while wrapped in gauze and pointed away from the face to catch any spray/droplets
  • No Recapping: Needles must never be recapped, bent, or broken by hand

Personal Protective Equipment (PPE)

PPE is specialized clothing or equipment worn by an employee for protection against a hazard. It is considered the last line of defense and is used when engineering and work practice controls cannot eliminate exposure

  • Gloves: Must be worn when hand contact with blood, mucous membranes, or non-intact skin is reasonably anticipated. Gloves must be replaced if torn or contaminated and must never be washed or reused
  • Laboratory Coats: Fluid-resistant lab coats or gowns must be worn to protect street clothes and skin. They must be buttoned/secured and removed before leaving the testing area
  • Face Protection: Masks in combination with eye protection devices (goggles or glasses with solid side shields), or chin-length face shields, must be worn whenever splashes, spray, spatter, or droplets of blood may be generated (e.g., during the manual opening of vacutainers or segments)

Hepatitis B Vaccination Program

OSHA mandates that the Hepatitis B vaccination series be made available to all employees who have occupational exposure. This is a critical preventative measure for Blood Bank personnel

  • Availability: The vaccine must be offered at no cost to the employee, at a reasonable time and place, and within 10 working days of initial assignment
  • Declination: Employees have the right to decline the vaccination. However, they must sign a mandatory OSHA-specified declination form
  • Re-evaluation: An employee who initially declines the vaccine may decide to accept the vaccination at a later date, at which time the employer must provide it
  • Titer Check: Post-vaccination testing for anti-HBs (antibody to Hepatitis B surface antigen) is recommended to verify immunity (seroconversion)

Post-Exposure Management

Despite all precautions, accidents occur. The laboratory must have a clearly defined Post-Exposure Prophylaxis (PEP) plan for needlesticks, cuts, or mucous membrane splashes

  • Immediate Action
    • Percutaneous (Needlestick/Cut): Wash the site immediately and thoroughly with soap and water
    • Mucous Membrane (Splash): Flush splashes to the nose, mouth, or skin with water. Irrigate eyes with clean water, saline, or sterile irrigants (eyewash station)
  • Reporting: The exposure must be reported to the supervisor immediately. An incident report documenting the route of exposure and the circumstances must be filed
  • Medical Evaluation: The employer must provide a confidential medical evaluation and follow-up. This includes:
    • Testing the source individual (patient/donor) for HBsAg, HCV, and HIV (if consent is obtained or legally not required)
    • Testing the exposed employee’s blood to establish baseline serological status
    • Providing prophylaxis (e.g., Hepatitis B Immune Globulin, antiretrovirals) as medically indicated

Decontamination & Waste Management

Proper housekeeping is essential to prevent cross-contamination and accidental exposure

  • Disinfection: Work surfaces must be decontaminated with an appropriate disinfectant after completion of procedures, immediately when overtly contaminated with blood, and at the end of the work shift
    • Hypochlorite Solution: A 1:10 dilution of household bleach (sodium hypochlorite) is the standard broad-spectrum disinfectant effective against HIV and Hepatitis B. It should be made fresh daily or as per manufacturer stability instructions
    • EPA-Registered Disinfectants: Commercial tuberculocidal disinfectants are also acceptable
  • Biohazard Waste: Regulated waste (liquid or semi-liquid blood, contaminated items that would release blood in a liquid or semi-liquid state if compressed, and pathological and microbiological wastes) must be placed in containers that are closable, constructed to contain all contents and prevent leakage, and labeled with the Biohazard Symbol (fluorescent orange or orange-red)